145 results on '"Federica, Cipriani"'
Search Results
102. Assessment and Follow-Up of Patency After Lymphovenous Microsurgery for Treatment of Secondary Lymphedema in External Male Genital Organs
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Sylvain Mukenge, Federica Cipriani, Andrea Moriondo, Daniela Negrini, Marco Catena, Gianfranco Ferla, Patrizio Rigatti, Francesca Ratti, Alberto Briganti, Mukenge, Sm, Catena, M, Negrini, D, Ratti, F, Moriondo, A, Briganti, Alberto, Rigatti, P, Cipriani, F, and Ferla, G. more...
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Indocyanine Green ,Male ,Microsurgery ,medicine.medical_specialty ,Time Factors ,Secondary lymphedema ,Urology ,medicine.medical_treatment ,Anastomosis ,Pampiniform plexus ,Veins ,chemistry.chemical_compound ,medicine ,Humans ,Lymphedema ,Derivation ,Radical surgery ,Aged ,Fluorescent Dyes ,Lymphatic Vessels ,business.industry ,Anastomosis, Surgical ,Lymphography ,medicine.disease ,Surgery ,Treatment Outcome ,Italy ,medicine.vein ,chemistry ,Scrotum ,medicine.symptom ,business ,Indocyanine green - Abstract
Secondary lymphedema of external male genital organs is a frequent complication of pelvic radical surgery following pelvic lymphadenectomy. Microsurgical lymphovenous anastomoses are usually performed using only the superficial scrotal lymphatics, excluding testicular lymphatic drainage. We have experimented using a new microsurgical technique based on lymphovenous anastomosis between the collectors of the spermatic funiculus and the veins of the pampiniform plexus, allowing testicular lymphatic drainage. The study included 11 patients with external genital organ lymphedema, five of whom were subjected to microsurgical lymphovenous derivation. At 3, 6, and 12 mo after surgery, the patency of lymphovenous anastomoses was assessed by noninvasive lymphography using indocyanine green fluorescence images obtained with the Photodynamic Eye (PDE) infrared camera system (Hamamatsu Photonics K.K., Hamamatsu, Japan). Progressive improvement of clinical conditions was assessed both by patients' self evaluation and by objective clinical follow-up based on: (1) PDE lymphography, (2) tomography of the pubic area, (3) recovery of the soft consistency of the scrotal tissue, (4) recovery of the scrotal skin normochromic aspect, (5) absence of pain, and (6) disappearance of edema with evident reduction of the scrotal and penile dimensions and normal palpability of the testis. The present study shows that lymphovenous anastomosis is a valuable method of resolving the edematous condition. The indocyanine green approach for lymphangiography is a very supportive method during follow-up because, with the least invasive approach, it is possible to ascertain the complete patency of the anastomosis, to confirm its localization, and to assess its lymphatic drainage. more...
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- 2011
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103. Impact of the implementation of ERAS program in complex liver resections: a propensity score-based analysis between open and laparoscopic approach
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Guido Fiorentini, Federica Cipriani, Marco Catena, Luca Aldrighetti, Michele Paganelli, Francesca Ratti, and A. Cardella
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medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Propensity score matching ,Gastroenterology ,Medicine ,Liver resections ,business - Published
- 2019
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104. Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study
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Lauren Scovel, Brice Gayet, Isacco Damoli, Leonardo Solaini, Ales Tomazic, Steven A. White, Frederik Berrevoet, M Del Chiaro, Federica Cipriani, Adnan Alseidi, Carlo Lombardo, Gianpaolo Balzano, Marco Montorsi, N. Nowbray, O.R.C. Busch, Ignasi Poves, M. Kusar, Laureano Fernández-Cruz, Robert P. Sutcliffe, Bård I. Røsok, Andrea Klock, Santiago Sánchez-Cabús, I. Kabir, M. Rawashdeh, M. Orville, John N. Primrose, Guido A. M. Tiberio, Claudio Bassi, K. Menon, Tobias Keck, Giovanni Butturini, Uwe A. Wittel, Giovanni Marchegiani, Ugo Boggi, Safi Dokmak, Francesca Aleotti, Sjors Klompmaker, R. Van Dam, David Fuks, Zeeshan Ateeb, Claudio Ricci, Francesca Gavazzi, B. Groot Koerkamp, Thilo Hackert, Bilal Al-Sarireh, R. Souche, Mushegh A. Sahakyan, Ulrich F. Wellner, Massimo Falconi, C.H.J. van Eijck, Olivier Farges, Roberto Troisi, Bjørn Edwin, Jean-Michel Fabre, Per Sandström, Zahir Soonawalla, Riccardo Casadei, Alessandro Giardino, T. de Rooij, Marc G. Besselink, M. Abu Hilal, Igor Khatkov, Keith J. Roberts, J. van Hilst, Andrea Pietrabissa, Isabella Frigerio, Raffaele Pugliese, Matthias Hassenpflug, Bergthor Björnsson, Alessandro Zerbi, R. Marshall, and Antonello Forgione more...
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medicine.medical_specialty ,Pan european ,Hepatology ,business.industry ,Propensity score matching ,medicine ,Gastroenterology ,Ductal adenocarcinoma ,Distal pancreatectomy ,business ,Surgery - Published
- 2019
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105. Laparoscopic vs Open Surgery for Colorectal Liver Metastases
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Michele Paganelli, Marco Catena, Luca Aldrighetti, Francesca Ratti, Federica Cipriani, Guido Fiorentini, Ratti, F, Fiorentini, G, Cipriani, F, Catena, M, Paganelli, M, and Aldrighetti, L
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Adult ,Male ,Laparoscopic surgery ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Operative Time ,Blood Loss, Surgical ,Disease-Free Survival ,Cohort Studies ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Clinical endpoint ,Humans ,Propensity Score ,Laparoscopy ,Original Investigation ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Liver Neoplasms ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Italy ,030220 oncology & carcinogenesis ,Propensity score matching ,Cohort ,Female ,030211 gastroenterology & hepatology ,Neoplasm Recurrence, Local ,Colorectal Neoplasms ,business ,Cohort study - Abstract
Importance Surgery represents the mainstay treatment of colorectal liver metastases. Indications for the laparoscopic approach in this setting have been widened and there is a need to confirm the benefits of minimally invasive liver surgery (MILS) in patients with complex disease states. Objective To compare outcomes of laparoscopic surgery with those of open surgery for liver metastases from colorectal cancer, focusing on the characteristics of modern MILS and therefore overcoming possible selection bias related to different policies for patients’ eligibility for MILS over time. Design, Setting, and Participants A cohort study of 885 resections performed for liver metastases from colorectal cancer between January 1, 2004, and June 30, 2017, at the Hepatobiliary Surgery Unit of San Raffaele Hospital, Milano, Italy, comprising 187 laparoscopic and 698 open resections. Procedures performed using the MILS approach with a ratio of MILS to total resections per year of more than 30% were considered and were matched by propensity scores (ratio of 1:4) to procedures performed using the open approach with a ratio of MILS to total resections per year of less than 30%. Main Outcomes and Measures The primary end point was short-term outcomes, including morbidity, mortality, functional recovery, and interval between surgery and adjuvant treatments; the secondary end point was long-term outcomes. Results Among this cohort (104 patients in the MILS group; 46 women and 58 men; median age, 62 years [range, 35-81 years]; and 412 patients in the open group; 181 women and 231 men; median age, 60 years [range, 37-80 years]), primary end-point data showed a significantly higher incidence of postoperative morbidity in patients who underwent open resections compared with those who underwent MILS (94 [22.8%] vs 21 [20.2%];P = .04). Patients in the MILS group had fewer major complications (Dindo-Clavien grades III-V) compared with patients in the open group (Dindo-Clavien grades III-V; 7 [6.7%] vs 35 [8.5%];P = .03) as well as shorter lengths of stay (median [range] duration, 3 [2-35] vs 5 [4-37] days;P = .02). Oncologic results were not compromised by the laparoscopic approach. Conclusions and Relevance In this study, the results of the propensity score matching analysis between modern laparoscopic surgery and previous open surgery appear to confer more comparable cohorts for complexity, further supporting the advantages of laparoscopy in the surgical treatment of liver metastases from colorectal cancer. The increase in use that laparoscopy has experienced appears to be based on increased feasibility, widening of eligibility criteria for patients, enhanced clinical effectiveness, and oncologic outcomes. All these elements together suggest that up to 70% of patients appear to be candidates for this minimally invasive surgical approach in high-volume centers. more...
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- 2018
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106. Continuous paravertebral thoracic block in enhanced recovery programmes for open right hepatectomy: A comparative study from a single institution
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Roberta Meroni, Federica Cipriani, Raffaella Reineke, Carmine D. Votta, Luca Aldrighetti, Luigi Beretta, Francesca Ratti, Reineke, Raffaella, Meroni, Roberta, Votta, Carmine, Cipriani, Federica, Ratti, Francesca, Aldrighetti, Luca, and Beretta, Luigi more...
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medicine.medical_specialty ,Nutrition and Dietetics ,Enhanced recovery ,business.industry ,Endocrinology, Diabetes and Metabolism ,Block (telecommunications) ,medicine.medical_treatment ,Anesthesia ,medicine ,Single institution ,Hepatectomy ,business ,Surgery - Published
- 2016
107. Outcome and Learning Curve in 159 Consecutive Patients Undergoing Total Laparoscopic Hemihepatectomy
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Mohammed Abu Hilal, Marcel J. van der Poel, Neil W. Pearce, Susan van Dieren, John N. Primrose, Marc G. Besselink, T. Armstrong, Federica Cipriani, Arjun Takhar, Other departments, and Surgery
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Blood Loss, Surgical ,030230 surgery ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Interquartile range ,Left Hemihepatectomy ,Hepatectomy ,Humans ,Medicine ,Laparoscopy ,Survival rate ,Aged ,Retrospective Studies ,Intention-to-treat analysis ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Conversion to Open Surgery ,Intention to Treat Analysis ,Surgery ,Survival Rate ,Treatment Outcome ,030220 oncology & carcinogenesis ,Cohort ,Female ,Clinical Competence ,business ,Learning Curve - Abstract
Importance: Widespread implementation of laparoscopic hemihepatectomy is currently limited by its technical difficulty, paucity of training opportunities, and perceived long and harmful learning curve. Studies confirming the possibility of a short and safe learning curve for laparoscopic hemihepatectomy could potentially benefit the further implementation of the technique.Objective: To evaluate the extent and safety of the learning curve for laparoscopic hemihepatectomy.Design, Setting, and Participants: A prospectively collected single-center database containing all laparoscopic liver resections performed in our unit at the University Hospital Southampton National Health Service Foundation Trust between August 2003 and March 2015 was retrospectively reviewed; analyses were performed in December 2015. The study included 159 patients in whom a total laparoscopic right or left hemihepatectomy procedure was started (intention-to-treat analysis), including laparoscopic extended hemihepatectomies and hemihepatectomies with additional wedge resections, at a tertiary referral center specialized in laparoscopic hepato-pancreato-biliary surgery.Main Outcomes and Measures: Primary end points were clinically relevant complications (Clavien-Dindo grade ?III). The presence of a learning curve effect was assessed with a risk-adjusted cumulative sum analysis.Results: Of a total of 531 consecutive laparoscopic liver resections, 159 patients underwent total laparoscopic hemihepatectomy (105 right and 54 left). In a cohort with 67 men (42%), median age of 64 years (interquartile range [IQR], 51-73 years), and 110 resections (69%) for malignant lesions, the overall median operation time was 330 minutes (IQR, 270-391 minutes) and the median blood loss was 500 mL (IQR, 250-925 mL). Conversion to an open procedure occurred in 17 patients (11%). Clinically relevant complications occurred in 17 patients (11%), with 1% mortality (death within 90 days of surgery, n?=?2). Comparison of outcomes over time showed a nonsignificant decrease in conversions (right: 14 [13%] and left: 3 [6%]), blood loss (right: 550 mL [IQR, 350-1150 mL] and left: 300 mL [IQR, 200-638 mL]), complications (right: 15 [14%] and left: 4 [7%]), and hospital stay (right: 5 days [IQR, 4-7 days] and left: 4 days [IQR, 3-5 days]). Risk-adjusted cumulative sum analysis demonstrated a learning curve of 55 laparoscopic hemihepatectomies for conversions.Conclusions and Relevance: Total laparoscopic hemihepatectomy is a feasible and safe procedure with an acceptable learning curve for conversions. Focus should now shift to providing adequate training opportunities for centers interested in implementing this technique. more...
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- 2016
108. Impact of Enhanced Recovery After Surgery (ERAS) approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma. A comparative study from a single institution
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Luigi Beretta, Luca Aldrighetti, Federica Cipriani, Laura Comotti, Marco Catena, Raffaella Reineke, Francesca Ratti, Ratti, Francesca, Cipriani, Federica, Reineke, Raffaella, Catena, Marco, Comotti, Laura, Beretta, Luigi, and Aldrighetti, Luca A. M. more...
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Liver surgery ,medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Endocrinology, Diabetes and Metabolism ,General surgery ,030230 surgery ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Medicine ,Single institution ,business ,Enhanced recovery after surgery - Published
- 2016
109. Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial☆
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Luigi Beretta, Raffaella Reineke, Francesca Ratti, Federica Cipriani, Laura Comotti, Luca Aldrighetti, Michele Paganelli, Marco Catena, Ratti, F, Cipriani, F, Reineke, R, Catena, M, Paganelli, M, Comotti, L, Beretta, Luigi, and Aldrighetti, L. more...
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Male ,medicine.medical_specialty ,Blood transfusion ,Time Factors ,Central Venous Pressure ,medicine.medical_treatment ,Operative Time ,Blood Loss, Surgical ,030230 surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Predictive Value of Tests ,Risk Factors ,Monitoring, Intraoperative ,Medicine ,Hepatectomy ,Humans ,Blood Transfusion ,Prospective Studies ,Laparoscopy ,Prospective cohort study ,Aged ,Proportional Hazards Models ,Chi-Square Distribution ,medicine.diagnostic_test ,Hepatology ,business.industry ,Central venous pressure ,Gastroenterology ,Reproducibility of Results ,Stroke Volume ,Stroke volume ,Middle Aged ,Conversion to Open Surgery ,Surgery ,Preload ,Treatment Outcome ,Italy ,030220 oncology & carcinogenesis ,Predictive value of tests ,Multivariate Analysis ,Original Article ,Female ,business - Abstract
Central venous pressure (CVP) is used as a marker of cardiac preload to control intraoperative blood loss in open hepatectomies, while its reliability in laparoscopy is less certain. The aim of this randomized prospective trial was to evaluate the outcome of laparoscopic resections performed with stroke volume variation (SVV) or CVP monitoring.All candidates for laparoscopic liver resection were assigned randomly to SVV or to CVP groups. Outcome was evaluated included conversion rate, cause of conversion, intraoperative blood loss, need for transfusions, length of surgery and postoperative results.Ninety consecutive patients were enrolled: both SVV and CVP groups included 45 patients each and were comparable in terms of patient and disease characteristics. A reduced rate of conversion was recorded in the SVV compared to the CVP group (6.7% and 17.8% respectively, p = 0.02). Blood loss was lower in the SVV group (150 mL), compared to the CVP group (300 mL, p = 0.04). Morbidity, mortality, length of stay and functional recovery were comparable. On multivariate analysis, lesion location, extent of hepatectomy and type of cardiac preload monitoring were associated significantly to risk of conversion.SVV monitoring in laparoscopic liver surgery improves intraoperative outcome, thus enhancing the benefits of the minimally-invasive approach and fast-track protocols. more...
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- 2015
110. Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases
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John N. Primrose, M. Abu Hilal, Louise Stanton, M. Rawashdeh, T. Armstrong, Arjun Takhar, Federica Cipriani, and Neil W. Pearce
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Adult ,Male ,medicine.medical_specialty ,Operative Time ,Kaplan-Meier Estimate ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,Prospective Studies ,Laparoscopy ,Prospective cohort study ,Propensity Score ,Lymph node ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,Liver Neoplasms ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Chemotherapy regimen ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Propensity score matching ,Observational study ,Female ,business ,Colorectal Neoplasms - Abstract
Background There is a need for high-level evidence regarding the added value of laparoscopic (LLR) compared with open (OLR) liver resection. The aim of this study was to compare the surgical and oncological outcomes of patients with colorectal liver metastases (CRLM) undergoing LLR and OLR using propensity score matching to minimize bias. Methods This was a single-centre retrospective study using a prospective database of patients undergoing liver resection for CRLM between August 2004 and April 2015. Co-variates selected for matching included: number and size of lesions, tumour location, extent and number of resections, phase of surgical experience, location and lymph node status of primary tumour, perioperative chemotherapy, unilobar or bilobar disease, synchronous or metachronous disease. Prematching and postmatching analyses were compared. Surgical and oncological outcomes were analysed. Results Some 176 patients undergoing LLR and 191 having OLR were enrolled. After matching, 133 patients from each group were compared. At prematching analysis, patients in the LLR group showed a longer overall survival (OS) and higher R0 rate than those in the OLR group (P = 0·047 and P = 0·030 respectively). Postmatching analyses failed to confirm these results, showing similar OS and R0 rate between the LLR and OLR group (median OS: 55·2 versus 65·3 months respectively, hazard ratio 0·70 (95 per cent c.i. 0·42 to 1·05; P = 0·082); R0 rate: 92·5 versus 86·5 per cent, P = 0·186). The 5-year OS rate was 62·5 (95 per cent c.i. 45·5 to 71·5) per cent) for OLR and 64·3 (48·2 to 69·5) per cent for LLR. Longer duration of surgery, lower blood loss and morbidity, and shorter postoperative stay were found for LLR on postmatching analysis. Conclusion Propensity score matching showed that LLR for CRLM may provide R0 resection rates and long-term OS comparable to those for OLR, with lower blood loss and morbidity, and shorter postoperative hospital stay. more...
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- 2015
111. Laparoscopic parenchymal-sparing resection of segment eight
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B. Jaber, Moh'd Abu Hilal, M. Rawashdeh, Elisa Francone, and Federica Cipriani
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medicine.medical_specialty ,Hepatology ,business.industry ,Parenchyma ,Gastroenterology ,Medicine ,business ,Resection ,Surgery - Published
- 2016
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112. Enhanced recovery after open hepatectomy with minimally invasive haemodynamic monitoring: A successful challenge. A comparative study from a single institution
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Carmine D. Votta, Luigi Beretta, Roberta Meroni, Francesca Ratti, Luca Aldrighetti, Raffaella Reineke, Federica Cipriani, Reineke, Raffaella, Meroni, Roberta, Votta, Carmine, Ratti, Francesca, Cipriani, Federica, Aldrighetti, Luca, and Beretta, Luigi more...
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medicine.medical_specialty ,Nutrition and Dietetics ,Enhanced recovery ,business.industry ,Endocrinology, Diabetes and Metabolism ,Anesthesia ,medicine.medical_treatment ,medicine ,Hepatectomy ,Single institution ,Invasive haemodynamic monitoring ,business ,Surgery - Published
- 2016
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113. Laparascopic distal pancreatectomy. Does size matter?
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B. Jaber, Awad Shamali, Federica Cipriani, M. Rawashdeh, and M. Abu Hilal
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medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,medicine ,Distal pancreatectomy ,business ,Surgery - Published
- 2016
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114. Total laparoscopic hemihepatectomy: Outcome and learning curve in 159 consecutive patients
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John N. Primrose, Arjun Takhar, T. Armstrong, Federica Cipriani, Marc G. Besselink, Neil W. Pearce, M. van der Poel, M. Abu Hilal, and S. van Dieren
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medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,business ,Outcome (game theory) ,Surgery - Published
- 2016
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115. Liver metastases from kidney cancer
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Francesca Ratti, Federica Cipriani, Luca Aldrighetti, Enrico Pinotti, Pinotti, E., Ratti, F., Cipriani, F., and Aldrighetti, L.
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Oncology ,medicine.medical_specialty ,Chemotherapy ,Kidney ,business.industry ,medicine.medical_treatment ,Cancer ,Disease ,medicine.disease ,Vascular endothelial growth factor ,chemistry.chemical_compound ,medicine.anatomical_structure ,chemistry ,Renal cell carcinoma ,Internal medicine ,medicine ,Stage (cooking) ,business ,Kidney cancer - Abstract
Kidney cancer is the ninth most frequent cause of malignant tumors in developed countries. Liver metastases from kidney cancer are present in 20.3 % of metastatic kidney cancers. In patient with metastatic kidney cancer, staging is a fundamental step to determine both prognosis and therapeutical approach. Options for treatment of liver metastases from renal cancer include surgery, ablative therapies, and chemotherapy. Indications vary depending on the stage of the disease, presence of extrahepatic metastases, and general status of patients. more...
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- 2015
116. Laparoscopic Parenchymal-Sparing Resections for Nonperipheral Liver Lesions, the Diamond Technique: Technical Aspects, Clinical Outcomes, and Oncologic Efficiency
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Elisa Francone, M. Rawashdeh, Arjun Takhar, T. Armstrong, Mohammad Abu Hilal, Federica Cipriani, Vishal G Shelat, Neil W. Pearce, Luca Aldrighetti, Cipriani, F, Shelat, Vg, Rawashdeh, M, Francone, E, Aldrighetti, L, Takhar, A, Armstrong, T, Pearce, Nw, and Abu Hilal, M more...
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Adult ,Male ,medicine.medical_specialty ,Liver resections ,Actuarial survival ,Resection ,Blood loss ,medicine ,Hepatectomy ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Curative intent ,business.industry ,Mortality rate ,Liver Neoplasms ,Perioperative ,Middle Aged ,Survival Analysis ,Surgery ,Treatment Outcome ,Feasibility Studies ,Operative time ,Female ,Laparoscopy ,business - Abstract
BACKGROUND: Surgical management of liver lesions has moved toward "parenchymal-sparing" strategies. Although open parenchymal-sparing liver resections are supported by encouraging results, the applicability of the laparoscopic approach for nonperipheral tumors is still questionable. Our aim was to assess the feasibility, safety, and oncologic adequacy of laparoscopic parenchymal-sparing liver resection for nonperipheral lesions with a description of the technique adopted in this setting. STUDY DESIGN: A prospectively collected single-center database of 517 laparoscopic liver resections was reviewed. Laparoscopic nonperipheral parenchymal-sparing liver resections (LapPSLRs), that is, entirely intraparenchymal limited resections performed on nonperipheral lesions, were selected. Intra-and perioperative outcomes were analyzed along with 3-year actuarial survival for patients with colorectal liver metastases. RESULTS: The group comprised 49 LapPSLRs. Colorectal liver metastases were the most frequent diagnosis (n = 24 patients). Lesions were located in segments 8, 7, 4a, and 3 in 51%, 8.2%, 36.7%, and 4.1% of cases, respectively. Conversion occurred in 4 patients (8%). Intra-and postoperative short-term outcomes were calculated for the 24 isolated LapPSLR (not associated with any concurrent liver resection). Median operative time and blood loss were 215 minutes and 225 mL, respectively. Pringle maneuver was used in 75% of cases. Postoperative 90-day mortality was nil and morbidity rate was 12.5%. Median postoperative stay was 3 days. Median tumor-free margin was 4 mm and 100% R0 rate was achieved for all LapPSLRs with curative intent. Three-year overall, recurrence-free, and disease-free survival rates were 100%, 65.2%, and 69.6%, respectively. CONCLUSIONS: Laparoscopic parenchymal-sparing liver resections for nonperipheral liver lesions are feasible and can be performed safely without compromising perioperative and oncological outcomes. (J Am Coll Surg 2015; 221: 265e272. (C) 2015 by the American College of Surgeons) more...
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- 2015
117. Laparoscopic Liver Surgery in Benign Liver Lesions
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Federica Cipriani, Vishal G. Shelat, and Mohammad Abu Hilal
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Liver surgery ,medicine.medical_specialty ,Benign disease ,medicine.diagnostic_test ,Minimal access surgery ,business.industry ,General surgery ,Cosmesis ,Return to work ,Resection ,medicine ,Laparoscopy ,business ,Hospital stay - Abstract
Laparoscopic liver surgery is expanding, and many studies have demonstrated the safety, feasibility, and advantages of the laparoscopic approach. Laparoscopic liver resection is a routine approach for a variety of liver lesions. Incidental benign liver lesions are increasingly diagnosed due to widespread availability and application of modern imaging. It is important to note that availability of laparoscopic liver surgery should not lead to relaxation in surgical indications for benign liver lesions. A multidisciplinary discussion should proceed prior to recommendation of surgery in benign liver lesions. Some of the benefits of minimal access surgery like shorter hospital stay, early return to work, and improved cosmesis are more appealing to young patients with benign disease. We believe that whenever a liver resection is indicated for benign liver lesions, laparoscopic approach should be considered if expertise is available. Laparoscopic liver resection should only be performed in specialized centers. more...
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- 2015
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118. Focal nodular hyperplasia
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Michele Paganelli, Francesca Ratti, Renato Finazzi, Luca Aldrighetti, Marco Catena, Federica Cipriani, Enrico Pinotti, Pinotti, E., Ratti, F., Cipriani, F., Paganelli, M., Catena, M., Finazzi, R., and Aldrighetti, L. more...
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medicine.medical_specialty ,Liver tumor ,business.industry ,Focal nodular hyperplasia ,medicine.disease ,Asymptomatic ,Malignant transformation ,Hemangioma ,Liver ,Benign ,Hepatic surgery ,Medicine ,In patient ,Surgery ,Radiology ,medicine.symptom ,business - Abstract
Focal nodular hyperplasia (FNH) is a benign tumorlike condition of the liver with no known potential for malignant transformation. FNH accounts for approximately 8 % of all primary hepatic tumors and is the second most common benign liver tumor after hemangioma. FNH is in most of cases an asymptomatic incidental finding. The stability in size of most FNH lesions, the lack of potential for malignant transformation, and the extremely low risk of rupture and hemorrhage support a conservative approach for management of most patients with radiologically convincing or histologically proven FNH. When symptoms occur, in patients in with the diagnosis is not clear and if there is the evidence of progressive growth surgery should be considered. more...
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- 2015
119. Laparoscopic major hepatectomies: current trends and indications. A comparison with the open technique
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Francesca Ratti, Riccardo Ariotti, Federica Cipriani, Michele Paganelli, Fabio Giannone, Luca Aldrighetti, Ratti, F, Cipriani, F, Ariotti, R, Giannone, F, Paganelli, M, and Aldrighetti, L
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Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,Operative Time ,Risk Assessment ,Patient Positioning ,Statistics, Nonparametric ,Lesion ,Postoperative Complications ,Blood loss ,medicine ,Hepatectomy ,Humans ,In patient ,Propensity Score ,Laparoscopy ,Aged ,Retrospective Studies ,Laparotomy ,medicine.diagnostic_test ,business.industry ,Patient Selection ,Liver Neoplasms ,Length of Stay ,Middle Aged ,Functional recovery ,Survival Analysis ,Surgery ,Treatment Outcome ,Italy ,Anesthesia ,Propensity score matching ,Female ,Disease characteristics ,medicine.symptom ,business ,Follow-Up Studies ,Abdominal surgery - Abstract
Diffusion of laparoscopic major hepatectomies is experiencing a steady increasing trend, although slower compared to minor resections. The aim of this single-center study is to discuss current trends and indications in the application of minimally invasive techniques to major hepatic resections. Preoperative patients and disease characteristics of 49 laparoscopic major hepatectomies (LPS group), performed between 2005 and 2015, were compared with 585 open hepatectomies (Open group) to analyze differences in patients recruitment. Factors which were found to be differently distributed between groups were used as covariates in a propensity score-based case-matched analysis with a 1:3 ratio between LPS group and 147 patients from the Open group (constituting Open-mat group). Short-term outcome was analyzed in matched groups. ASA score, previous abdominal surgery, previous interventional procedures, indication, lesion size and associated procedures were significantly different between the LPS and the Open group. Short-term outcome analysis revealed that blood loss (200 vs 350 mL, p = 0.044) and time for functional recovery (3 vs 4 days, p = 0.05) were reduced in the LPS compared to the Open-mat group, in spite of longer length of surgery (260 vs 170 min, p = 0.041) and comparable oncological adequacy. Even though data on technical feasibility of laparoscopic major resections and their benefits in terms of blood loss and functional recovery support the diffusion of minimally invasive approach, the limit of the technique is still represented by the reduced pool of suitable candidates. more...
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- 2015
120. The Influence of Aging on Hepatic Regeneration and Early Outcome after Portal Vein Occlusion: A Case-Control Study
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Federica Cipriani, Luca Aldrighetti, Nadia Russolillo, Luca Viganò, Alessandro Ferrero, Francesca Ratti, Serena Langella, Russolillo, N, Ratti, F, Vigano, L, Langella, S, Cipriani, F, Aldrighetti, L, and Ferrero, A more...
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Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Aging ,Organoplatinum Compounds ,medicine.medical_treatment ,Portal vein ,Irinotecan ,Preoperative care ,Diabetes Complications ,Young Adult ,Sex Factors ,Occlusion ,Antineoplastic Combined Chemotherapy Protocols ,Preoperative Care ,medicine ,Hepatectomy ,Humans ,Young adult ,Aged ,Aged, 80 and over ,business.industry ,Portal Vein ,Regeneration (biology) ,Liver Neoplasms ,Case-control study ,Age Factors ,Organ Size ,Middle Aged ,Embolization, Therapeutic ,Liver regeneration ,Neoadjuvant Therapy ,Surgery ,Liver Regeneration ,Bevacizumab ,Oxaliplatin ,Radiography ,Biliary Tract Neoplasms ,Oncology ,Liver ,Chemotherapy, Adjuvant ,Case-Control Studies ,Camptothecin ,Female ,Fluorouracil ,business - Abstract
Portal vein occlusion (PVO) is used to increase inadequate future liver remnant volume (FLRV). Impaired liver regeneration has been reported in aged animals. This study was designed to evaluate the impact of patient age on hepatic regeneration. Sixty patients aged a parts per thousand yen70 years were matched 1:1 with 60 patients aged < 70 years. Matching criteria were sex, diabetes, cirrhosis, pre-PVO chemotherapy and bevacizumab administration, and jaundice. The median ages in the older and younger groups were 76 (range 70-83) years and 59 (range 20-69) years, respectively (p < 0.001). Median FLRV following PVO (33.1 +/- A 6.8 vs. 31.9 +/- A 6.0 %) and volumetric increase (0.52 +/- A 0.35 vs. 0.49 +/- A 0.34) were similar in the two groups. Of the older and younger patients, 10 % and 1.7 %, respectively, did not undergo liver surgery after PVO (p = 0.051). Mortality (5.5 vs. 6.7 %) and major morbidity (25.9.8 vs. 22 %) rates were similar. Liver failure rate was higher in older patients (35.1 vs. 16.9 %, p < 0.026), mainly due to Grade A liver failure (20.3 vs. 8.4 %, p < 0.001). Multivariate analysis showed that age a parts per thousand yen 70 years [odds ratio (OR) 3.03; 95 % confidence interval (CI) 1.18-7.78; p = 0.020] and biliary cancer diagnosis (OR 4.69; 95 % CI 1.81-12.09; p = 0.001) were independent risk factors for postoperative liver failure. Liver regeneration after PVO is not impaired by age. Nevertheless, liver resection in elderly patients is performed less often after PVO and carries a higher risk of liver failure. more...
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- 2014
121. Strategies to Increase the Resectability of Patients with Colorectal Liver Metastases: A Multi-center Case-Match Analysis of ALPPS and Conventional Two-Stage Hepatectomy
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Michele Masetti, Luca Bonariol, Erik Schadde, Francesca Ratti, Elio Jovine, Matteo Zanello, Nicolò Bassi, Matteo Serenari, Luca Aldrighetti, Marco Massani, Federica Cipriani, Ratti, Francesca, Schadde, Erik, Masetti, Michele, Massani, Marco, Zanello, Matteo, Serenari, Matteo, Cipriani, Federica, Bonariol, Luca, Bassi, Nicolò, Aldrighetti, Luca, Jovine, Elio, Ratti, F, Schadde, E, Masetti, M, Massani, M, Zanello, M, Serenari, M, Cipriani, F, Bonariol, L, Bassi, N, Aldrighetti, L, and Jovine, E more...
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Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,alpps ,Colorectal Neoplasm ,Gastroenterology ,Surgical oncology ,Internal medicine ,Occlusion ,medicine ,Hepatectomy ,Humans ,Stage (cooking) ,Ligation ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Portal Vein ,Liver Neoplasms ,Perioperative ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,Match analysis ,Survival Rate ,Oncology ,Case-Control Studies ,Propensity score matching ,Feasibility Studies ,Female ,business ,Colorectal Neoplasms ,Follow-Up Studies - Abstract
Background: Two-stage hepatectomy (TSH) is well established for the treatment of patients who have colorectal cancer liver metastases (CRLM) with a small liver remnant. The technique of associating liver partitioning and portal vein occlusion for staged hepatectomy (ALPPS) has been advocated as a novel tool to increase resectability. Using a case-match design, this study aimed to compare TSH and ALPPS for patients with CRLM.Methods: All patients undergoing ALPPS for CRLM at three major hepatobiliary centers in Italy (ALPPS group) were compared in a case-match analysis with patients undergoing TSH (TSH group) at a single institution. The groups were matched with a 1:3 ratio using propensity scores based on covariates representing severity of metastatic disease. The main end points of the study were feasibility of complete resection and intra- and postoperative outcomes.Results: The two treatments did not differ significantly in feasibility. Two patients in the TSH group dropped out compared with no patients in the ALPPS group. A comparable volume gain in future liver remnant (FLR) was obtained in the ALPPS and TSH groups (47 vs. 41 %, nonsignificant difference) but during a shorter interval in ALPPS group. The overall and major complication rate was significantly higher after stage 2 in the ALPPS group (Clavien ≥ 3a: 41.7 vs. 17.6 % in TSH group; p = 0.025).Conclusion: The feasibility of resection using ALPPS compared with TSH for CRLM was not significantly greater, but perioperative complications were increased. Therefore, ALPPS should be proposed to patients with caution and warnings. Currently, TSH remains the standard approach for performing R0 resection in patients with advanced CRLM and inadequate FLR. more...
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- 2014
122. Liver failure in patients treated with chemotherapy for colorectal liver metastases: Role of chronic disease scores in patients undergoing major liver surgery. A case-matched analysis
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Luca Aldrighetti, Federica Cipriani, Francesca Ratti, Marco Catena, Michele Paganelli, Ratti, F, Cipriani, F, Catena, M, Paganelli, M, and Aldrighetti, L
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Oncology ,Male ,medicine.medical_specialty ,Organoplatinum Compounds ,medicine.medical_treatment ,Matched-Pair Analysis ,Angiogenesis Inhibitors ,Antineoplastic Agents ,Chronic liver disease ,Antibodies, Monoclonal, Humanized ,Gastroenterology ,Group B ,Risk Factors ,Internal medicine ,medicine ,Hepatectomy ,Humans ,In patient ,Aspartate Aminotransferases ,Aged ,Retrospective Studies ,Liver injury ,Chemotherapy ,Receiver operating characteristic ,business.industry ,Platelet Count ,Liver Neoplasms ,Liver failure ,General Medicine ,Middle Aged ,medicine.disease ,Neoadjuvant Therapy ,Oxaliplatin ,Bevacizumab ,ROC Curve ,Chronic Disease ,Surgery ,Female ,Chemical and Drug Induced Liver Injury ,business ,Colorectal Neoplasms ,Liver Failure ,medicine.drug - Abstract
Aim: An accurate and noninvasive tool to predict Chemotherapy Associated Liver Injury (CALI) still lacks. Study aimed to evaluate chronic liver disease scores (Aspartate aminotransferase to Platelet Ratio Index, APRI and Fibrosis-4, FIB-4) as Postoperative Liver Failure (PLF) predictors in patients treated with Oxaliplatin for Colorectal Liver Metastases (CLM). Methods: 8 patients who developed PLF after major hepatectomy (Group B) were compared to 24 patients who did not develop PLF (Group A) in a case-matched analysis for patients and disease characteristics. ROC curves analysis was performed to assess score accuracy. Results: In Group A number of CT cycles was lower, (6 vs 9, p NS), interval between treatment and surgery was longer (11 vs 7 weeks, p < 0.05) and bevacizumab was more frequently administered (66.7% vs 37.5%, p < 0.05). In Group B median APRI score was 0.53 (range: 0.86-4.26) whereas in Group A was 0.30 (range: 0.06-2.21, p < 0.05). Median FIB-4 score was 2.46 (range: 0.86-13.65) in Group B and 1.58 (range: 0.27-7.68) in Group A (p < 0.001). Multivariate analysis showed a significant correlation between APRI and the onset of PLF. A good accuracy of APRI score was evident in ROC curves with an area under the curve of 0.72 (p 0.003). Conclusions: APRI score is calculated considering both liver damage and platelet count, it is cost effective and easily available. This study demonstrates that there is a good accuracy in PLF prediction and consequently in CT induced liver damage evaluation. (C) 2014 Elsevier Ltd. All rights reserved. more...
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- 2014
123. Defining indications to ALPPS procedure: Technical aspects and open issues
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Luca Aldrighetti, Francesca Ratti, Marco Catena, Annalisa Gagliano, Michele Paganelli, Federica Cipriani, Ratti, F., Cipriani, F., Gagliano, A., Catena, M., Paganelli, M., and Aldrighetti, L.
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Portal vein ligation ,Sepsis ,In situ transection ,medicine ,Postoperative outcome ,Hepatectomy ,Humans ,Hypetrophy ,Aged ,Liver resection ,business.industry ,Portal Vein ,Patient Selection ,Disease progression ,Liver Neoplasms ,Liver failure ,Organ Size ,Middle Aged ,medicine.disease ,Surgery ,Liver ,Biliary tract ,Hepatic parenchyma ,Future liver remnant ,Lymph Node Excision ,Female ,ALPPS ,business ,Colorectal Neoplasms ,Tomography, X-Ray Computed - Abstract
The limit to surgical treatment of patients with hepatic tumors is represented by the proportion of residual hepatic parenchyma at the end of surgery (FLR, future liver remnant) that provides an estimation of the risk of postoperative liver failure. Recently, a new two-stage technique has been developed with the acronym (ALPPS) associating liver partitioning and portal vein ligation for staged hepatectomy with the aim of obtaining a more rapid and effective increase in FLR, even though indications are not clear yet. Between January and December 2012, eight patients were candidates to ALPPS at the Hepatobiliary Surgery Unit of San Raffaele Hospital, Milan. The first three patients (Series 1) underwent right trisectionectomy and were affected by tumors infiltrating biliary confluence, while the others (Series 2) were candidates to right hepatectomy for colorectal liver metastases. Two patients were then excluded from Series 2 because intraoperative finding of irresectable disease. Intra- and postoperative outcome was evaluated with the aim of defining indications to ALPPS. All patients reached an adequate FLR after a median of 7.5 days from the first procedure (rate of program completion 100 %). In Series 1 two patients developed complications related to bile leakage from the raw surface of the liver to be resected and septic events secondary to ischemic necrosis of the liver segment IV. One patient died following multi-organ failure secondary to sepsis. In Series 2 postoperative course was uneventful in all the patients, and in particular no patient showed disease progression between the two procedures or signs of postoperative liver failure. ALPPS approach was initially considered suitable for patients affected by Klatskin tumors who require, despite a small tumor volume, extended hepatectomies associated with surgery of the biliary tract: the analysis of this first series of patients has led to a re-evaluation of the indication to this strategy, as a consequence of encountered criticisms. Actually only a subset of patients affected by colorectal liver metastases are candidates to ALPPS. © 2013 Springer-Verlag Italia. more...
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- 2014
124. Single-access laparoscopic liver resections
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Luca Aldrighetti, Michele Paganelli, Federica Cipriani, Francesca Ratti, Fabio Ferla, Marco Catena, Cipriani, F., Ratti, F., Ferla, F., Paganelli, M., Catena, M., and Aldrighetti, L.
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Laparoscopic surgery ,Liver surgery ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Laparoscopic hepatectomy ,Biological Stress ,General surgery ,Postoperative pain ,Liver resections ,medicine ,Postoperative outcome ,business ,Hospital stay - Abstract
Liver surgery is one of the last areas where the minimally invasive technique spread, in view of the considerable technical difficulties associated. The feasibility and efficacy of laparoscopic liver resections have gradually been demonstrated, along with the benefits that this procedure provides to postoperative outcome as compared to the open technique, in particular by reducing the length of hospital stay. Therefore, these results have encouraged the use of the single-site approach for liver resections, in an attempt to reduce the invasiveness and biological stress associated with the procedure, to further improve the outcome after surgery. Several reports have demonstrated the feasibility and safety in selected cases of liver resections, and technical dissertations have already been processed. The possible postoperative benefits of the procedure have already been highlighted, in particular in terms of reduced postoperative pain, even if the real benefits have yet to be confirmed, as well as its oncological adequacy. Single-site liver resections remain a highly challenging procedures to be performed by experienced surgeons in both hepatic and laparoscopic surgery. more...
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- 2014
125. Robot-Assisted Versus Open Liver Resection in the Right Posterior Section
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Federica Cipriani, Alberto Patriti, Francesca Ratti, Luca Aldrighetti, Luciano Casciola, Graziano Ceccarelli, Alberto Bartoli, Patriti, A, Cipriani, F, Ratti, F, Bartoli, A, Ceccarelli, G, Casciola, L, and Aldrighetti, L more...
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Male ,medicine.medical_specialty ,Transfusion rate ,Carcinoma, Hepatocellular ,Hepatocellular carcinoma ,Operative Time ,Liver ,Liver metastasis ,Liver resection ,Robot-assisted liver resection ,Female ,Hepatectomy ,Humans ,Laparoscopy ,Liver Neoplasms ,Middle Aged ,Robotics ,Treatment Outcome ,Surgery ,Blood loss ,Tumor stage ,Scientific Papers ,medicine ,Open liver resection ,Performance status ,business.industry ,General surgery ,medicine.disease ,Cohort ,Right posterior ,business - Abstract
Background Open liver resection is the current standard of care for lesions in the right posterior liver section. The objective of this study was to determine the safety of robot-assisted liver resection for lesions located in segments 6 and 7 in comparison with open surgery. Methods Demographics, comorbidities, clinicopathologic characteristics, surgical treatments, and outcomes from patients who underwent open and robot-assisted liver resection at 2 centers for lesions in the right posterior section between January 2007 and June 2012 were reviewed. A 1:3 matched analysis was performed by individually matching patients in the robotic cohort to patients in the open cohort on the basis of demographics, comorbidities, performance status, tumor stage, and location. Results Matched patients undergoing robotic and open liver resections displayed no significant differences in postoperative outcomes as measured by blood loss, transfusion rate, hospital stay, overall complication rate (15.8% vs 13%), R0 negative margin rate, and mortality. Patients undergoing robotic liver surgery had significantly longer operative time (mean, 303 vs 233 minutes) and inflow occlusion time (mean, 75 vs 29 minutes) compared with their open counterparts. Conclusions Robotic and open liver resections in the right posterior section display similar safety and feasibility. more...
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- 2014
126. The Italian Experience in Minimally Invasive Surgery of the Liver: A National Survey
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Francesca Ratti, Fulvio Calise, Federica Cipriani, Luca Aldrighetti, and Luciano Casciola
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Laparoscopic surgery ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General surgery ,Invasive surgery ,medicine ,Liver resections ,business ,Surgery ,Resection - Abstract
In 2009, the most comprehensive review of published series of minimally invasive liver resection (MILR) reported nearly 3,000 cases performed worldwide, emphasizing an exponential growth in the application of this technique by surgeons experienced with both hepatic and laparoscopic surgery [1]. The goal of our survey was to provide an overview of the spread of the minimally invasive approach to liver resections in Italy. more...
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- 2013
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127. Left Lateral Sectionectomy: Laparoscopic Approach
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Michele Paganelli, Francesca Ratti, Luca Aldrighetti, Federica Cipriani, and Gianfranco Ferla
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Liver surgery ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Liver segment ,Gold standard ,Surgery ,Resection ,Single site ,Hepatic surgery ,medicine ,Patient awareness ,Laparoscopy ,business - Abstract
Interest in laparoscopic liver surgery (LLS) has increased since first being described [1], thanks to the possibility of reducing postoperative pain and disability, shortening hospital stay and time required for functional recovery, the growing experience in both laparoscopy and hepatic surgery, continual technological progress, and patient awareness about the benefits of this approach [2, 3]. Many series are available in the literature regarding laparoscopic resections of any liver segment, and even major hepatectomies are perfomed in selected cases [4]. Regardless, the laparoscopic approach is at present suggested as the gold standard only for left lateral sectionectomy [5] (according to Brisbane classification [6]) or left lobectomy, intending resection of segments 2 and 3 (S2, S3) (according to Couinaud). Experience gained in recent years has improved results of this type of surgery, even thanks in part to the learning-curve effect [7], and has led to continual research of minimal invasiveness through the Laparo-Endoscopic Single Site (LESS) surgery, which is now used also for liver surgery, especially for left lobectomy [8, 9]. more...
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- 2013
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128. Liver resection for hepatocellular carcinoma within a fast-track management: a propensity-score matched analysis between open and laparoscopic approach
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Michele Paganelli, Francesca Ratti, Luca Aldrighetti, Luigi Beretta, Marco Catena, Federica Cipriani, and Raffaella Reineke
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Liver surgery ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Resection ,Surgery ,Oncology ,Hepatocellular carcinoma ,Propensity score matching ,Medicine ,Fast track ,business ,Laparoscopy ,Enhanced recovery after surgery - Published
- 2016
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129. Learning curve assessment in 102 laparoscopic distal pancreatectomies: Single-surgeon series
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Marc G. Besselink, Jony van Hilst, Thijs de Rooij, Federica Cipriani, Mohammed Abu Hilal, and M. Rawashdeh
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medicine.medical_specialty ,Hepatology ,Series (mathematics) ,business.industry ,Endocrinology, Diabetes and Metabolism ,General surgery ,Gastroenterology ,medicine ,business ,Single surgeon - Published
- 2016
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130. Intraoperative monitoring of stroke volume variation allows to improve the intraoperative outcome of laparoscopic liver surgery. A prospective randomized comparative study
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Luigi Beretta, Laura Comotti, Michele Paganelli, Francesca Ratti, Marco Catena, Federica Cipriani, Raffaella Reineke, and Luca Aldrighetti
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Liver surgery ,medicine.medical_specialty ,Hepatology ,business.industry ,Anesthesia ,Gastroenterology ,Medicine ,Stroke volume ,business ,Outcome (game theory) ,Surgery - Published
- 2016
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131. Laparoscopic liver resection of segment 1 for malignant lesions in three different clinical settings
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Elisa Francone, Moh'd Abu Hilal, M. Rawashdeh, Federica Cipriani, and Bashar Jaber
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medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,Clinical settings ,business ,Resection ,Surgery - Published
- 2016
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132. Impact of eras approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma. A comparative study from a single institution
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Luca Aldrighetti, Annalisa Gagliano, Raffaella Reineke, Laura Comotti, Francesca Ratti, Luigi Beretta, Marco Catena, and Federica Cipriani
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Liver surgery ,medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Hepatocellular carcinoma ,Gastroenterology ,Medicine ,Single institution ,business ,medicine.disease ,Outcome (game theory) ,Surgery - Published
- 2016
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133. Surgical approach to multifocal hepatocellular carcinoma with portal vein thrombosis and arterioportal shunt leading to portal hypertension and bleeding: a case report
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Francesca Ratti, Luca Aldrighetti, Michele Paganelli, Federica Cipriani, Gianfranco Ferla, Ratti, Francesca, Cipriani, Federica, Paganelli, Michele, Ferla, Gianfranco, and Aldrighetti, L
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Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Portal venous pressure ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,arterioportal shunt ,lcsh:RC254-282 ,Hypertension, Portal ,Ascites ,medicine ,Paracentesis ,Humans ,Portasystemic Shunt, Surgical ,portal vein thrombosis ,HCC ,liver surgery ,Venous Thrombosis ,medicine.diagnostic_test ,Portal Vein ,business.industry ,Liver Neoplasms ,lcsh:RD1-811 ,Middle Aged ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Embolization, Therapeutic ,Portal vein thrombosis ,Venous thrombosis ,Oncology ,Portal hypertension ,Surgery ,Radiology ,medicine.symptom ,Hepatectomy ,Gastrointestinal Hemorrhage ,Varices ,business - Abstract
It is reported the case of a 69 years man who presented to the Emergency Room because of pain and abdominal distension from ascites. After admission and paracentesis placement, he developed a digestive hemorrhage due to oesophageal varices from portal ipertension secondary to the formation of a portal shunt concomitant with a multifocal HepatoCellular Carcinoma (HCC) with portal vein thrombosis (PVT). The patient underwent endoscopic varices ligation, twice transarterial embolization (TAE) of arterial branches feeding the shunt and subsequent left hepatectomy. During the postoperative course he developed mild and transient signs of liver failure and was discharged in postoperative day 16. He is alive and disease free 8 months after surgery. more...
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- 2012
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134. Laparoscopic Hepatic Transection Using Stapler and CUSA
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Marco Catena, Luca Aldrighetti, Michele Paganelli, Francesca Ratti, and Federica Cipriani
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Laparoscopic surgery ,medicine.medical_specialty ,surgical procedures, operative ,Blood loss ,medicine.diagnostic_test ,business.industry ,Hemostasis ,medicine.medical_treatment ,medicine ,Laparoscopy ,business ,Liver parenchyma ,Surgery - Abstract
Laparoscopy is associated with reduced blood loss and morbidity. Efficient and safe laparoscopic liver transection is dependent on the ability to simultaneously address two tasks: parenchymal division and hemostasis. Over the past years, technological advances have led to the development of specific instruments for liver transection, such as the ultrasonic dissector (CUSA) and stapler device, also for laparoscopic surgery. The former allows to fracture hepatocytes along the proposed line of division, leaving intact arteries, veins, and bile ducts crossing the line of division, and the uncovered bridging structures are then sealed and divided. Stapler use is reported in both transection of large vessels and parenchymal transection, especially in laparoscopy. more...
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- 2012
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135. LESS technique for liver resection: the progress of the mini-invasive approach: A single-centre experience
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Federica Cipriani, Michele Paganelli, Luca Aldrighetti, Francesca Ratti, Fabio Ferla, Marco Catena, Cipriani, F, Catena, M, Ratti, F, Paganelli, M, Ferla, F, and Aldrighetti, L
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Adult ,Male ,medicine.medical_specialty ,Resection ,Mini invasive surgery ,Postoperative Complications ,Blood loss ,medicine ,Hepatectomy ,Humans ,Aged ,business.industry ,Mortality rate ,Liver Neoplasms ,Middle Aged ,medicine.disease ,Surgery ,Single centre ,Treatment Outcome ,Italy ,Heart failure ,Aortic valve stenosis ,Operative time ,Female ,Laparoscopy ,business - Abstract
Introduction: During the last years, the safety and efficacy of the laparoscopic approach for liver masses located in the left lobe have been demonstrated, encouraging the mini-invasive approach and, in more recent times, the LESS technique (Laparo Endoscopic Single Site), in an attempt to reduce the biological invasiveness related to surgical trauma. Material and methods: From January 2009 to December 2010, 39 patients underwent laparoscopic liver resection at our institution. In 14 of these, the LESS technique was used. The aim of our study is to evaluate the short-term outcome of this group of patients. Results: We recorded the following results: Mean operative time of 187 min (range 145-420 min), mean intraoperative blood loss of 214 ml (range 50-700 ml), postoperative morbidity rate of 21.4%, one postoperative death (related to acute heart failure related to severe aortic valve stenosis). Excluding this patient from the statistical analysis, the morbidity rate was 14.3%. The median hospital stay was five days. Discussion: The LESS technique for liver resections is safe and effective in selected patients and in centres with high expertise in laparoscopic liver surgery. more...
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- 2012
136. Biliary cystadenoma: short- and long-term outcome after radical hepatic resection
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Gianfranco Ferla, Fabio Ferla, Francesc A. Ratti, Michele Paganelli, Federica Cipriani, and Luc A. Aldrighetti
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medicine.medical_specialty ,medicine.medical_treatment ,Cystadenoma ,Intrahepatic bile ducts ,Risk Factors ,Laparotomy ,medicine ,Hepatectomy ,Humans ,Cyst ,Cystadenocarcinoma ,Incidental Findings ,Bile duct ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Bile Duct Neoplasms ,Female ,Laparoscopy ,Hepatic Cyst ,business - Abstract
The intrahepatic biliary cystadenoma is a rare benign tumor of the liver, originating from an intrahepatic bile duct: it becomes symptomatic only when it causes obstruction of the bile duct itself. Regardless of the various diagnostic modalities available, it is difficult to distinguish preoperatively the cystadenoma both from a simple liver cyst, and from a cystic carcinoma of the bile duct. An incomplete surgical removal of the cyst often results in a higher risk of size increase and recurrence, even considering that the lesion may degenerate into a cystadenocarcinoma. Between January 2004 and May 2011, 1,173 liver resections were carried out at the Hepatobiliary Surgery Unit of San Raffaele Hospital: 12 of these were performed for cystadenoma. Forty-six patients underwent laparoscopic liver cysts deroofing: definitive histological examination in six of these patients revealed instead the diagnosis of cystadenoma. In 50% of cases, the diagnosis of cystadenoma was therefore acquired as a result of an incidental finding. The patients were all female, median age 45 years. The liver resection included six cases of left hepatectomy, three left lobectomies, and three of the right hepatectomy. The operations were performed by laparotomy, with the exception of two left lobectomies completed laparoscopically. In all cases, the postoperative course was without major complications. The resection was radical in all cases and the median hospital stay was 5 days. At a median follow-up of 16 months (range 7–30), all patients are alive and disease free. Biliary cystadenomas can easily be misunderstood and interpreted as simple hepatic cysts. Radical surgical resection is necessary and provides good short- and long-term outcomes. more...
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- 2011
137. Italian experience in minimally invasive liver surgery: a national survey
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Aldrighetti, L, Belli, G, Boni, L, Cillo, U, Ettorre, G, De Carlis, L, Pinna, A, Casciola, L, Calise, F, Corrado, F, Federica, C, Francesca, R, Elisa, C, Enrico, G, Roberto, S, Stefano, D, Antonio, G, Paolo, R, Marcello, S, Mario, M, Marco, F, Giuseppe, N, Giorgio, E, Alberto, P, Lorenzo, C, Marco, C, Gennaro, N, Mario, G, Nicolo`, B, Maria di Ca`, S, Alberto, B, Giovanni, S, Maurizio, B, Elio, J, Marco, S, Francesco, C, Valle Raffaele, D, Michele, C, Riuniti, O, Pietro, M, Carmine Gianfranco, D, Alfredo, G, Isidoro, D, Salvatore, G, Adelmo, A, Goffredo, C, Vincenzo, S, Carlo, D, Piero, M, Aldrighetti, Luca, Belli, Giulio, Boni, Luigi, Cillo, Umberto, Ettorre, Giuseppe, De Carlis, Luciano, Pinna, Antonio, Casciola, Luciano, Calise, Fulvio, Corrado, Fantini, Federica, Cipriani, Francesca, Ratti, Elisa, Cassinotti, Enrico, Gringeri, Roberto, Santoro, Stefano, Di Sandro, Antonio, Giuliani, Paolo, Reggiani, Roberto, Santambrogio, Marcello, Spampinato, Mario, Morino, Marco, Filauro, Giuseppe, Navarra, Giorgio, Ercolani, Alberto, Patriti, Lorenzo, Capussotti, Marco, Casaccia, Gennaro, Nuzzo, Mario, Guerrieri, Nicolo`, Bassi, Maria di Ca`, S., Alberto, Brolese, Giovanni, Sgroi, Maurizio, Buonanno, Elio, Jovine, Marco, Spada, Francesco, Corcione, Valle Raffaele, Dalla, Michele, Colledan, Riuniti, Ospedali, Pietro, Mezzatesta, Carmine Gianfranco, Di Somma, Alfredo, Guglielmi, Isidoro, Di Carlo, Salvatore, Gruttadauria, Adelmo, Antonucci, Goffredo, Caldarera, Vincenzo, Scuderi, Carlo, De Werra, Piero, Maida, Aldrighetti, L, Belli, G, Boni, L, Cillo, U, Ettorre, G, De Carlis, L, Pinna, A, Casciola, L, Calise, F, Corrado, F, Federica, C, Francesca, R, Elisa, C, Enrico, G, Roberto, S, Stefano, D, Antonio, G, Paolo, R, Marcello, S, Mario, M, Marco, F, Giuseppe, N, Giorgio, E, Alberto, P, Lorenzo, C, Marco, C, Gennaro, N, Mario, G, Nicolo`, B, Maria di Ca`, S, Alberto, B, Giovanni, S, Maurizio, B, Elio, J, Marco, S, Francesco, C, Valle Raffaele, D, Michele, C, Riuniti, O, Pietro, M, Carmine Gianfranco, D, Alfredo, G, Isidoro, D, Salvatore, G, Adelmo, A, Goffredo, C, Vincenzo, S, Carlo, D, Piero, M, Aldrighetti, Luca, Belli, Giulio, Boni, Luigi, Cillo, Umberto, Ettorre, Giuseppe, De Carlis, Luciano, Pinna, Antonio, Casciola, Luciano, Calise, Fulvio, Corrado, Fantini, Federica, Cipriani, Francesca, Ratti, Elisa, Cassinotti, Enrico, Gringeri, Roberto, Santoro, Stefano, Di Sandro, Antonio, Giuliani, Paolo, Reggiani, Roberto, Santambrogio, Marcello, Spampinato, Mario, Morino, Marco, Filauro, Giuseppe, Navarra, Giorgio, Ercolani, Alberto, Patriti, Lorenzo, Capussotti, Marco, Casaccia, Gennaro, Nuzzo, Mario, Guerrieri, Nicolo`, Bassi, Maria di Ca`, S., Alberto, Brolese, Giovanni, Sgroi, Maurizio, Buonanno, Elio, Jovine, Marco, Spada, Francesco, Corcione, Valle Raffaele, Dalla, Michele, Colledan, Riuniti, Ospedali, Pietro, Mezzatesta, Carmine Gianfranco, Di Somma, Alfredo, Guglielmi, Isidoro, Di Carlo, Salvatore, Gruttadauria, Adelmo, Antonucci, Goffredo, Caldarera, Vincenzo, Scuderi, Carlo, De Werra, and Piero, Maida more...
- Abstract
This survey provides an overview about current spread of Minimally Invasive Liver Resection (MILR) in Italy. Primary endpoint was to assess evolution of MILR in recent years and its degree of application among centres with different experience in laparoscopic and hepatic surgery. A questionnaire with items describing activity MILR was sent to Italian surgical centers. Diagnosis, technical approaches, resection extent, devices and vascular control, reasons for conversion, morbidity and mortality were recorded. Level of expertise per centre was analysed in terms of learning curve acquisition and relationship with hepatobiliary background. 1497 MILRs from 39 centers (median 27 patients/center, range 1–145, period 1995–2012) were collected. Conversion rate was 10.7 % (180 patients out of 1677, excluded from subsequent analysis), with bleeding representing most frequent cause of conversion (34.4 %). Eleven centers completed learning curve, performing >60 MILR. Benign lesions were 27.5 % and malignant 72.5 %, with hepatocellular carcinoma being the most frequent indication. 92.6 % of cases were performed with a totally laparoscopic technique (1.3 % were hand-assisted, 1.9 % single-port and 4.2 % robotic). Minor resections accounted for 92.9 % (left lateral sectionectomy resulted the most frequent procedure; 23.8 %), while major resections represented 7.1 %. Overall mortality was 0.2 % (3 of 1497 patients) and morbidity 22.8 %. Mean length of stay was 5 days. Correlation between MILR activity and a hepatobiliary background was not clear comparing MILR cases and liver resection volumes per center. MILR has been significantly widespread in Italy in recent years, with several centers having definitely completed the learning curve as attested by clinical results consistent with major series from the Western and Eastern countries. MILR programs in Italy seem to arise from both centers with specific hepatob more...
- Published
- 2015
138. Case-Matched Analysis of Totally Laparoscopic Versus Open Liver Resection for HCC: Short and Middle Term Results
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Federica Cipriani, Eleonora Guzzetti, Gianfranco Ferla, Luca Aldrighetti, Marco Catena, Carlo Pulitano, Michele Paganelli, Aldrighetti, L, Guzzetti, E, Pulitano, C, Cipriani, F, Catena, M, Paganelli, M, and Ferla, G more...
- Subjects
Male ,medicine.medical_specialty ,Cirrhosis ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Open Resection ,Medicine ,Hepatectomy ,Humans ,Prospective Studies ,Prospective cohort study ,Laparoscopy ,Survival rate ,Aged ,Neoplasm Staging ,medicine.diagnostic_test ,business.industry ,Mortality rate ,Liver Neoplasms ,General Medicine ,Perioperative ,Length of Stay ,medicine.disease ,Prognosis ,Surgery ,Survival Rate ,Oncology ,Case-Control Studies ,Female ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Background and Objectives Laparoscopy is gaining acceptance as a safe procedure for resection of liver neoplasms. The aim of this study is to evaluate surgical results and mid-term survival of minor hepatic resection performed for HCC. Methods Data of 16 patients with HCC, undergoing laparoscopic hepatectomy from September 2005 to January 2009, were compared to a control group of 16 patients who underwent open resection (OR) during the same period. The two groups were matched in terms of type of resection, tumor size, and severity of cirrhosis. Results One patient underwent conversion to an open approach. Laparoscopic approach resulted in shorter operating time (150 min, P:0.044) and lower blood loss (258 ml, P:0.008). There was no difference in perioperative morbidity and mortality rate; laparoscopic approach was associated with a shorter hospital stay (6.3 days, P:0.039). After a mean follow up of 32 months, disease free survival and overall survival were 40.2 and 23.3 months for laparoscopic group, and 47.7 and 31.4 months for OR group (P NS). Conclusion Laparoscopic resection of HCC is feasible and safe in selected patients and can result in good surgical results, with similar outcomes in terms of overall and disease-free survival. J. Surg. Oncol. J. Surg. Oncol. 2010;102:82–86. © 2010 Wiley-Liss, Inc. more...
- Published
- 2010
139. Erratum to: The Influence of Aging on Hepatic Regeneration and Early Outcome after Portal Vein Occlusion: A Case–Control Study
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Nadia Russolillo, Serena Langella, Alessandro Ferrero, Federica Cipriani, Francesca Ratti, Luca Viganò, and Luca Aldrighetti
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medicine.medical_specialty ,Oncology ,business.industry ,Surgical oncology ,Regeneration (biology) ,Occlusion ,Case-control study ,Portal vein ,Medicine ,Surgery ,business - Published
- 2015
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140. A Load Balancing Algorithm for LEO Satellite Networks
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Federica Cipriani and Anton Donner
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Algorithm ,Geography ,Low earth orbit ,Real-time computing ,Network performance ,LEO ,Load balancing (computing) ,Satellite Networks ,Multipath propagation ,Simulation ,Load Balancing - Abstract
*† In this paper we discuss the load balancing technique and in particular its application to low earth orbit (LEO) satellite networks. The problem of traffic splitting, that is the utilization of multiple paths between source and destination (multipath) is solved by forwarding the flows on all available paths in the network and minimizing a given cost function, such as average delay. The splitting of the incoming flow is applied taking into account the congestion state of the chosen paths at the moment of new connection set up. The simulation results point out improvements in the network performance when the load balancing is foreseen. more...
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- 2004
141. Erratum to: Pure Laparoscopic Liver Resection for Large Malignant Tumors: Does Size Matter?
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T. Armstrong, Mohammad Abu Hilal, Vishal G Shelat, Federica Cipriani, Neil W. Pearce, Tiago Basseres, and Arjun Takhar
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medicine.medical_specialty ,Text mining ,Oncology ,business.industry ,Surgical oncology ,Medicine ,Surgery ,Radiology ,business ,Resection - Published
- 2014
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142. Extending resectability and improving short-term outcome: 30 cases of two-stage hepatectomy for colorectal liver metastases
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Francesca Ratti, Luca Aldrighetti, C. Soldati, Marco Catena, Federica Cipriani, and M. Venturini
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medicine.medical_specialty ,Oncology ,Two stage hepatectomy ,business.industry ,General surgery ,medicine ,Surgery ,General Medicine ,business ,Outcome (game theory) ,Term (time) - Published
- 2010
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143. Evaluation of stress response in laparoscopic liver surgery: a prospective study of inflammatory profile, coagulation homeostasis and clinical outcome
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Renato Finazzi, Francesca Ratti, Luca Aldrighetti, Eleonora Guzzetti, Marco Catena, and Federica Cipriani
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Liver surgery ,medicine.medical_specialty ,business.industry ,General Medicine ,Gastroenterology ,Surgery ,Fight-or-flight response ,Oncology ,Coagulation ,Internal medicine ,medicine ,Prospective cohort study ,business ,Homeostasis - Published
- 2010
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144. Treatment of recurrent colorectal liver metastases: is repeat surgery safe and effective? A single centre experience
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Michele Paganelli, Marco Catena, Francesca Ratti, G. Ferla, Federica Cipriani, and Luca Aldrighetti
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Single centre ,medicine.medical_specialty ,Oncology ,business.industry ,General surgery ,Medicine ,Surgery ,General Medicine ,Repeat Surgery ,business - Published
- 2010
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145. IFN gene/cell therapy curbs colorectal cancer colonization of the liver by acting on the hepatic microenvironment
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Giulia Escobar, Antonio Esposito, Luigi Naldini, Andrea Monestiroli, Mario Catarinella, Luca G. Guidotti, Ngoc Lan Tran, Paolo Marra, Federica Cipriani, Matteo Iannacone, Luca Aldrighetti, Amleto Fiocchi, Roberto Aiolfi, Giovanni Sitia, Catarinella, Mario, Monestiroli, Andrea, Escobar, Giulia, Fiocchi, Amleto, Tran, Ngoc Lan, Aiolfi, Roberto, Marra, Paolo, Esposito, Antonio, Cipriani, Federica, Aldrighetti, Luca, Iannacone, Matteo, Naldini, Luigi, Guidotti, Luca G., and Sitia, Giovanni more...
- Subjects
Liver metastase ,0301 basic medicine ,Colorectal cancer ,Genetic enhancement ,medicine.medical_treatment ,Cell- and Tissue-Based Therapy ,Colorectal Neoplasm ,ddc:616.07 ,Metastasis ,Cell therapy ,Liver metastases ,Mice ,0302 clinical medicine ,Neoplasm Metastasis ,Research Articles ,Cancer ,Liver Neoplasms ,interferon‐alpha ,gene therapy ,3. Good health ,Neoplasm Metastasi ,Cytokine ,Tumor microenvironment ,Liver Neoplasm ,030220 oncology & carcinogenesis ,Molecular Medicine ,Survival Analysi ,Colorectal Neoplasms ,Human ,Research Article ,Interferon‐alpha ,Immunology ,colorectal cancer ,03 medical and health sciences ,Gene therapy ,medicine ,Animals ,Humans ,tumor microenvironment ,Progenitor cell ,Animal ,business.industry ,Interferon-alpha ,Genetic Therapy ,medicine.disease ,Survival Analysis ,Disease Models, Animal ,030104 developmental biology ,Genetics, Gene Therapy & Genetic Disease ,business ,liver metastases ,Homing (hematopoietic) - Abstract
Colorectal cancer (CRC) metastatic dissemination to the liver is one of the most life-threatening malignancies in humans and represents the leading cause of CRC-related mortality. Herein, we adopted a gene transfer strategy into mouse hematopoietic stem/progenitor cells to generate immune-competent mice in which TEMsa subset of Tie2(+) monocytes/macrophages found at peritumoral sitesexpress interferon-alpha (IFN), a pleiotropic cytokine with anti-tumor effects. Utilizing this strategy in mouse models of CRC liver metastasis, we show that TEMs accumulate in the proximity of hepatic metastatic areas and that TEM-mediated delivery of IFN inhibits tumor growth when administered prior to metastasis challenge as well as on established hepatic lesions, improving overall survival. Further analyses unveiled that local delivery of IFN does not inhibit homing but limits the early phases of hepatic CRC cell expansion by acting on the radio-resistant hepatic microenvironment. TEM-mediated IFN expression was not associated with systemic side effects, hematopoietic toxicity, or inability to respond to a virus challenge. Along with the notion that TEMs were detected in the proximity of CRC metastases in human livers, these results raise the possibility to employ similar gene/cell therapies as tumor site-specific drug-delivery strategies in patients withCRC. Colorectal cancer (CRC) metastatic dissemination to the liver is one of the most life-threatening malignancies in humans and represents the leading cause of CRC-related mortality. Herein, we adopted a gene transfer strategy into mouse hematopoietic stem/progenitor cells to generate immune-competent mice in which TEMs-a subset of Tie2+ monocytes/macrophages found at peritumoral sites-express interferon-alpha (IFNα), a pleiotropic cytokine with anti-tumor effects. Utilizing this strategy in mouse models of CRC liver metastasis, we show that TEMs accumulate in the proximity of hepatic metastatic areas and that TEM-mediated delivery of IFNα inhibits tumor growth when administered prior to metastasis challenge as well as on established hepatic lesions, improving overall survival. Further analyses unveiled that local delivery of IFNα does not inhibit homing but limits the early phases of hepatic CRC cell expansion by acting on the radio-resistant hepatic microenvironment. TEM-mediated IFNα expression was not associated with systemic side effects, hematopoietic toxicity, or inability to respond to a virus challenge. Along with the notion that TEMs were detected in the proximity of CRC metastases in human livers, these results raise the possibility to employ similar gene/cell therapies as tumor site-specific drug-delivery strategies in patients with CRC. more...
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